An innovative HIV/AIDS prevention and treatment support project
„Our vision is a world without HIV infected babies, where mothers with HIV/AIDS live long and healthy lives, raising their children and caring for their families. Our mission is to create an effective, sustainable model of care that provides education and support for pregnant women and new mothers living with HIV/AIDS: To prevent babies from contracting HIV through mother-to-child transmission; to keep mothers and babies living with HIV/AIDS alive and healthy by increasing their ability to access health-sustaining medical care; and to empower mothers to battle the stigma associated with HIV/AIDS in their families and their communities“
Nosipho, at seven months pregnant, visits her local clinic to access antenatal care and chooses to test for HIV. When she finds out that she is HIV-positive, Nosipho realizes she will have to cope with the struggles she has been warned about on billboards and has watched her neighbors endure. When she considers telling those close to her about her HIV-positive status, she becomes despondent and afraid: She worries about her family rejecting her and even more so, about her boyfriend's potentially violent response. A nurse at the clinic explains to Nosipho that she can pass the virus on to her baby, and she becomes even more afraid imagining giving birth to a sick baby: How would she take care of him, and how will she even take care of herself? At this time when she needs support most severely, she feels most alone.
Although Nosipho is not aware of it, about one third of the other women in the clinic waiting room are in a similar situation. Most will only get a few minutes of education and support from the overworked clinical staff as part of government prevention of mother-to-child (PMTCT) programmes: When they leave, they will know very little about what it means to be HIV-positive or how to best cope with the news.
Silent in her confusion and uncertainty, Nosipho looks to the nurse for reassurance. The nurse tells her about mothers2mothers (m2m), a group of HIV-positive mothers who are available to educate and counsel her. Down the hall in the m2m meeting room, she finds ten women sitting in a circle; they offer her a chair and welcome her to join the conversation. Over lunch, a Mentor Mother named Thandi pulls Nosipho aside and asks her how she is feeling and if she has any questions about the news. Thandi explains that there are medications she can take and behaviours she can adopt to reduce the likelihood that she will infect her child and to improve her own health. Rejoining the group, Nosipho listens to the other women's stories, some of whom have recently delivered healthy babies. She realizes many of them - and their children - are living healthy lives despite their HIV status.
What makes m2m different?
Nosipho is one of the mothers who was supported by and is now working with mothers2mothers (m2m). This innovative project was founded in Cape Town, South Africa, in 2001 by Mitch Besser. An American doctor working in the provincial hospital system, he witnessed women coming into clinics and hospitals for pregnancy tests and HIV testing. If testing positive, they were given a short consultation and then advised to return near the end of their pregnancy for single dose or short course anti-retroviral medicine, to prevent transmission to their baby. The patients received minimal counselling upon discovering their status, and little follow up care could be offered by overwhelmed medical staff. After delivery many of these women did not return to the clinics and hospitals for care, they simply fell through cracks in the system. As a result the number of babies born HIV positive was not diminishing, as the number of mothers getting sick and dying from AIDS was increasing.
mothers2mothers does not do testing or distribute medication. It is an education, psychosocial mentoring and support organization. This is critical to their success since the greatest problem with testing and anti-retroviral drug distribution today is a lack of uptake - through fear, stigma, lack of education, and language and culture barriers.
mothers2mothers identifies and trains HIV positive mothers from the communities who have recently given birth to healthy babies. They place them through a rigorous curriculum, and return them to maternity wards and clinics as Mentor Mothers. Mentor Mothers educate new mothers, supporting them as they confront decisions that mean the difference between illness and health. It is critical to the success of the program that Mentor Mothers are employed and paid as integral, valuable and professional members of the health care team. They operate in antenatal clinics, hospitals, maternity wards and post-delivery clinics alongside established PMTCT treatment programs. All of these services are provided within the state system and alongside other NGOs with whom m2m partner. m2m thus complements already existing PMTCT programs.
When a woman arrives for her first antenatal visit, she is paired with a Mentor Mother. This Mentor Mother performs an assessment to determine what the client understands about HIV and its ramifications for her health, her child’s health, and her life, and all the factors that influence her living. If the client desires, her Mentor Mother will accompany her to her medical appointments and aid the woman in completing referral appointments. Additionally, the Mentor Mothers lead group meetings and discussions with all the participating women in the program so that the women benefit from the support of others. The Mentor Mother also acts as an advocate on the labor wards, ensuring that treatment is provided during the birth process to prevent transmission.
mothers2mothers was developed in response to perceived medical and social needs to keep mothers in care after delivery. To address these factors, m2m also speaks to the postpartum woman’s questions and needs with regard to feeding, accessing family health care, and adjusting to life in the community as a woman and mother living with HIV. mothers2mothers acknowledges the physical and emotional challenges of the postpartum period.
Recognizing the importance of extending the program into the community, townships, and villages, mothers2mothers also utilizes the seasoned skills and talents of Mentor Mothers to provide community education and outreach on topics related to reproductive health, especially HIV/AIDS. Site Coordinators and Mentor Mothers regularly travel to clients’ homes and/or invite family members to a mothers2mothers location in order to provide education and support to women who are disclosing their HIV status. In addition, m2m adapts to rural health care settings where women cannot travel to the nearest health care facility for Antenatal Clinic visits and/or delivery, playing an integral role in promoting ARV therapy adherence.
Since its inception the programme has grown to include programmes for mothers and babies after delivery, to support women and families taking anti-retroviral drugs and to provide skills training and opportunities to earn a living. Mothers Creations, an m2m income generation project, provides economic opportunity to more than 100 women who have collectively earned more than four million rand in the last four years. Products from Mothers Creations are sold around the world. Each month m2m sites in South Africa see more than 20,000 women. More than 95% of the mothers in the programme are tested for HIV, versus a national average of 10%. Nearly all of them give birth to HIV negative children. The operating cost is $35,000 per clinic or hospital site, and less than $15 per client. m2m trains and employs many otherwise unemployed women, creating a cadre of healthcare professionals which the government cannot otherwise afford to deploy. Presently, m2m has more than 300 employees at 89 sites in South Africa, 10 sites in Lesotho, and partners with local organizations to promote similar programs in Ethiopia and Botswana. With new funding for 2007, m2m has plans to begin expansion into Kenya, Rwanda and Zambia.
Vital impact on PMTCT programs
mothers2mothers has a substantial positive impact on efforts to prevent the transmission of HIV from pregnant women and new mothers to their babies (PMTCT), according to an important public health study focusing on key indicators for the PMTCT programs. The study was conducted by Horizons/Population Council and Health Systems Trust (HST), an independent South African research organization. The study shows that PMTCT care substantially improved at sites after m2m services were introduced.
The study found that m2m's programs have a considerable impact on key factors involved in preventing mother-to-child transmission of HIV:
- Increasing the number of women who received the drugs to prevent transmission to infants
- Increasing the number of infants receiving the drug to prevent transmission of HIV
- Helping women to disclose their HIV status to their partners and families
- Improving women’s knowledge about how HIV can be transmitted from mothers to infants during pregnancy and breastfeeding
- Increasing the number of women who chose an exclusive infant feeding method which reduces transmission riskHelping women feel that they were better able to help themselves, care for their infants and live positively
- Increasing the number of women who received a CD4 test during pregnancy to make sure that the appropriate PMTCT drugs were given
- Improving the use of family planning after pregnancy
- Encouraging more women to discuss the importance of faithfulness and safer sex with their partners
The independent research took place at three healthcare facilities in Pietermaritzburg, in South Africa’s KwaZulu-Natal Province, from 2005 to 2006. The study looked at the impact of m2m's peer education and psychosocial support programs on the attitudes and behaviours of pregnant women and new mothers living with HIV/AIDS. Overall, the Horizons/Population Council study is an important study which demonstrates through empirical evidence, the value of the education and psychosocial support that mothers2mothers offers mothers living with HIVAIDS.**
…and women’s empowerment
Mothers living with HIV should be empowered to become active members of their community, rather than to live only as victims, is the basic understanding of m2m. In the words of Site Coordinator and mother speaking about her m2m experience: “I didn't want anything to do with HIV-positive people or women, but when I saw these healthy-looking women and listened to their stories, I immediately became part of that family. We actually created a bond, which will last forever. I was empowered and prepared for disclosure...”
*mothers2mothers (m2m) is an NGO based in Cape Town, South Africa, that offers an effective, sustainable model of care that provides education and support for pregnant women and new mothers living with HIV/AIDS. Contact: Linda Codron, Communications Manager, mothers2mothers, firstname.lastname@example.org, www.m2m.org
** Results from the study were released in May 2007. The final is expected
late 2007, see www.popcouncil.org/horizons/projects/SouthAfrica_Mothers2Mothers.htm